The MRCGP Recorded Consultation Assessment (RCA) has replaced the MRCGP CSA during the current coronavirus pandemic and will be running until at least August 2021. The pass rates for the CSA have always shown a significant difference between international medical graduates (IMGs) and UK graduates. In this article, Dr Rida Chandio shares her experience of preparing for the RCA as an IMG and shares 10 tips based on how she passed with flying colours.

I’m a GPST3 in my last 4 months of training (Yorkshire and Humber-Deanery) and passed RCA in first attempt this September with a recording period of under 4 weeks.

The RCGP had set clear guidance with regards to clinical coverage areas and obtaining consent was streamlined through the Fourteen-Fish platform when I started recording for RCA. I was given access to Fourteen-Fish four weeks prior to my submission and felt comfortable recording at my own pace and in a familiar environment.

CSA/ RCA is a challenging exam as it assesses whether a candidate is ready to practice as an independent Practitioner in the UK. From my personal experience, being an International Medical Graduate can put additional pressure to preparation, including transition into a patient-centred consultation style, efficient- time management skills to consult back to back in ten minutes and being able to manage non-medical (social issues) well.

Statistics from the past have shown that pass rate in IMGS for CSA has been 68% overall, of which scores for Non-EEA have been around 56.9%. But, fortunately for RCA I have come across a good mix of candidates who were previously unable to pass CSA, but have aced the RCA swiftly.

So, here are my 10 top tips based on my own experience – I hope it will be useful in your preparation.

1. Plan you day. First and foremost, plan your day and keep your trainer on board! Keep a a set-number of patients you feel comfortable consulting with on a daily basis allowing adequate time for debriefs and recordings and don’t overburden yourself.

2. Plan your cases. You can discuss with your trainer about getting your clinics booked in with patients presenting with new problems, that can help you tick most boxes for data gathering and management plan. You can start early and exchange patients from fellow colleagues’ clinic list which are best suited to the exam-requirement e.g swapping simple medication reviews with emergency contraception, new presentation of low mood, chest pain or shortness of breath etc. PDP days can also be used to open up clinic-slots as per your choice.

3. Record everything! The first few days of recording might feel very chaotic and challenging but trust me by the end of week one, you’ll become more organised and sleek at it. With fourteen fish platform the recordings are fairly straightforward and your clinical/ Educational supervisor can easily access your shared recordings, verify them and add comments at different sections of your recording for you to improve.

4. Ask you trainer to be brutally honest with you! Listen back to the recording with your trainer and you would always pick up something great to learn from. Take all those learning points as constructive criticism. Never let those discussions discourage you and aim to be your best version through this drill. Listening back to my recordings gave me an insight into those unwanted habits which were often unintentional. Reflect and improve.

5. Develop a consultation style which suits you well. THE NAKED CONSULTATION by Liz Moulton has been my go to text-book as an ST3 and has taught me this very basic concept of Thoughts, Hopes and Worries. Pushing ICE when it’s been given to you already, will get you to waste your precious time and would depict poor listening skills. Therefore, DON’T FORCE ICE and STICK TO TIME. Nothing would get marked beyond 10 minutes post- consent. Open up the consultation in a relaxed manner and leave some space for patients to speak up. For audio-recording keep a piece of paper and jot down important cues and later probe on the ones which are relevant.  

6. Revise your knowledge. I used NICE CKS red flags for the presenting complaint and skimmed through the possible management options for various presentations.

7. Keep it natural and keep it flowing! It is importnat that you don’t appear formulaic in your consultations. Keep a structure in your head whilst recording. Start with open questions, be empathetic in your tone by acknowledging important issues and explore psycho-social aspects earlier on in your consultation. Your recording should sound like a conversation and not an interview!

8. Remember clinical AND communication. Always remember that you would need both good communication and clinical skills to ace this exam. Develop a good clinical basis to approach history of presenting complaints, exclude red flags smoothly, acknowledge psycho-social aspects of the problem, summarise the data gathered and formulate a safe and shared management plan. Practice to divide your data gathering and management plan into 5 minutes each. Practise ‘chunk and check’ technique, which involves the sharing of management plan in little pieces and checking understanding after a few chunks of management plan shared. Remember to pause for things which are unclear to the patient  and allow adequate time.

9. Make sure you have a good selection of cases – both in terms of different curriculum areas, and level of challenge. CASES I SUBMITTED were:

• Subfertility
• HRT discussion for menopausal symptoms
• PSA counselling for a patient with family history of prostate cancer
• Baby colic
• Exercise induced asthma
• Tired all the time
• Insomnia
• Fibromyalgia
• Migraine with triggers
• Sore tongue and Covid-19 anxiety
• Orlistat initiation and lifestyle Counselling
• Mechanical back pain
• Depression

10. Last but not least, BELIEVE IN YOURSELF! The only exam you would ever find hard is the one you’ve not given or intend to give next. Always remember the 80/20 PARETO RULE-   20% of what you do leads to 80% of your results. Be strategic to WORK SMART AND NOT HARD!! I did this by choosing cases with moderate complexity to ensure maximum tick boxes for all three RCA-domains, sought regular feedback and reflected accordingly and stuck to a consultation- style which was mouldable for all different sorts of presentations and remained time-efficient.  

Courses and resources I found helpful in passing the RCA:

• I attended the Emedica RCA Masterclass and then the Emedica full day RCA intensive preparation course. The pre-course material focuses on covering detailed RCGP- CSA competencies with marking scheme and common pitfalls to avoid. One the full day course we went through 25 timed cases with professional simulators and I got 1:1 feedback which was thorough and realistic. The course feedback gave me insight into what the real examiners were looking for in a clear-pass candidate. I ultimately developed a strategy and aimed to pass this assessment with the best possible score.
• I then used the Emedica online CSA cases (these were included as part of the post course reading for the full day RCA course). There were 65 cases, and they include detailed patient instructions and examiners marking sheets for each case, and they cover major exam topics. You can keep those as a checklist for your recordings and would give you an insight into how real examiners mark those cases.
• I also listened to Dr Nigel Giam’s podcasts on youTube which I found useful in formulating a structured consultation.
• THE NAKED CONSULTATION by Liz Moulton

Of course every practice is unique, so there may be things that you will need to do slightly differently, but I hope you will find my experience and these tips helpful in preparing your RCA submission. Best wishes with your recordings and in passing your exam!

Dr Rida Chandio passed her RCA with a score of 25 above the pass mark and is due to complete here GP training and get her CCT at the start of 2021.